Have Venous Thromboembolism Rates Decreased in Total Hip and Knee Arthroplasty?

Sep 19, 2019The Journal of arthroplasty

Have Blood Clot Rates Decreased After Hip and Knee Replacement Surgery?

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Abstract

Approximately 1 in 71 patients undergoing total knee arthroplasty (TKA) developed a venous thromboembolism (VTE) within 30 days after surgery.

The overall incidence of VTE, deep vein thrombosis (DVT), pulmonary embolism (PE), and all-cause mortality for total hip arthroplasty (THA) patients were 0.6%, 0.4%, 0.3%, and 0.2%, respectively.
From 2008 to 2016, VTE, DVT, PE, and mortality rates showed no significant change in THA patients.
For TKA patients, the overall incidence of VTE, DVT, PE, and mortality were 1.4%, 0.9%, 0.6%, and 0.1%, respectively.
There were reductions in VTEs and DVTs from 2009 to 2016 for TKA patients, while a significant reduction in PEs was observed in 2016.
No significant change in mortality was noted for TKA patients during the study period.

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BACKGROUND: Venous thromboembolism (VTE) is a major cause of morbidity, mortality, and healthcare costs in arthroplasty patients. In an effort to reduce VTEs, numerous strategies and guidelines have been implemented, but their impact remains unclear. The purpose of this study is to compare annual trends in 30-day VTE, deep vein thrombosis (DVT), pulmonary embolism (PE), and all-cause mortality in (1) total hip arthroplasty (THA) and (2) total knee arthroplasty (TKA).

METHODS: The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database identified 363,530 patients who received a TKA or THA from 2008 to 2016. Bivariate analysis was performed to assess the association between the year in which surgery was performed and demographics and comorbidities. Bimodal multivariate logistic regression models for THA and TKA were developed for 2009-2016 using 2008 as a reference.

RESULTS: Overall incidence of VTE, DVT, PE, and mortality for THA were 0.6%, 0.4%, 0.3%, and 0.2%, respectively. Based off of multivariate regression VTE, DVT, PE, and mortality rates have shown no significant (P > .05) change from 2008 to 2016 in THA patients. Overall incidence of VTE, DVT, PE, and mortality for TKA were 1.4%, 0.9%, 0.6%, and 0.1%, respectively. Multivariate regression revealed reductions when compared to 2008 for VTEs and DVTs from 2009 to 2016 (P < .05) for TKA patients. A significant reduction in PEs (P = .002) was discovered for 2016, while no significant change was observed in mortality (P > .05).

CONCLUSION: Approximately 1 in 71 patient undergoing TKA, and 1 in 167 undergoing THA developed a VTE within 30 days after surgery. Our study demonstrated that VTE incidence rates have decreased in TKA, while remaining stable in THA over the past 8 years. Further research to determine the optimal prophylaxis algorithm that would allow for a personalized, efficacious, and safe thromboprophylaxis regimen is needed.

LEVEL OF EVIDENCE: III.

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Have Venous Thromboembolism Rates Decreased in Total Hip and Knee Arthroplasty?

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